Leading Chinese physicians visit LLUMC to learn about wound care
Takkin Lo (fourth from left), MD, MPH, director of hyperbaric and wound medicine at Loma Linda University Medical Center, with the visiting physicians and group from all across the People’s Republic of China.
At the beginning of November, five physicians from all across China spent a day at Loma Linda University Medical Center learning about hyperbaric and wound medicine from Takkin Lo, MD, MPH, director of hyperbaric and wound medicine at Loma Linda University Medical Center.
“They visited Loma Linda because we have a comprehensive wound care treatment center,” says Dr. Lo. “A surgical/acute wound is treated differently than a chronic wound. These doctors, who are thought leaders in this realm in China, wanted to learn the newer moist care treatment of wounds.”
The visiting physicians were Gao Fang, MD, associate chief physician, department of endocrinology and metabolism, Nanfang Hospital in Guangzhou; Rong Xinzhou, MD, PhD, director of the burn department at First Municipal Hospital of Guangzhou; Liu Bing, MD, PhD, director of vascular surgery at the Hospital of Harbin Medical University in Heilongjiang; Yuan Qun, MD, PhD, director of endocrinology at General Air Force Hospital in Beijing; and Cao Yemin, MD, PhD, director of vascular disease at Shanghai TCM-Integrated Hospital in Shanghai. These physicians, along with others from their country, are pushing to form the National Society of Wound Care in China. To this end, they wanted to tour the hyperbaric oxyen treatment area and the wound care center at LLUMC.
“Hopefully in the next 12 months we can help them put the framework in place for their society,” says Dr. Lo, who is currently serving as secretary of the board of directors of the Undersea and Hyperbaric Medicine Society (UHMS) in the United States, a prestigious position indicating national acceptance and recognition of Loma Linda University Medical Center.
The interest to develop a national wound society in China began a year ago. It came from the increasing frequency of chronic wounds due to the increasingly Westernized-diet (making people prone to ulcers). Physicians around China recognized the importance to have standardized protocols and treatment plans and began looking to form a national wound society. It was through contact with one of the vendors LLUMC works with, Medline, Inc., that the leading physicians of this movement discovered the wound care treatment center at LLUMC and learned about Dr. Lo’s use of hyperbaric medicine in wound care.
The visiting physicians listened to lectures on management of wounds and toured the wound care treatment center.
“They were very appreciative and impressed with our center,” says Dr. Lo. “They are specifically looking at how to treat chronic wounds.”
The trip was coordinated and funded by Guang Dong Pharmaceutical Import and Export, Inc; the Beijing JiaShen Medical Device Company; China Healthcare Group; and Medline, Inc.
“One of the reasons they chose to visit us is because we’re very engaged in wound and hyperbaric oxygen clinical research,” remarks Dr. Lo.
Moist wound care, which the Chinese physicians learned about from Dr. Lo, is keeping the wound closed for a moist environment to assist the healing process.
“It’s been recognized that it helps to heal and maintain healing,” says Dr. Lo. “We’re salvaging limbs by reducing the number of amputations of extremities with this method.”
The transition to moist wound care has taken place over the last 20 years and has really taken off in the last 10 years across the country.
“I have a team of people that provide the care from nurses to vascular surgeons, orthopaedic surgeons, to dieticians to diabetic specialists to respiratory therapists at the wound care treatment center,” says Dr. Lo. Hyperbaric medicine is one treatment option within the center.
Hyperbaric medicine, or high pressure medicine, had its origin in the 1950s when vascular and cardiothoracic surgeons in Amsterdam discovered that surgeries performed with 100 percent oxygen under high pressure decreased the morbidity and mortality of patients with ischemic tissues. It was observed that patients treated with oxygen under pressure, or hyperbaric oxygen (HBO), manifested a number of effects that resemble those of certain pharmacological agents. Over the years, there has been a better understanding of the different mechanisms of action for HBO. As a result, the field of hyperbaric medicine has expanded to include treatment of many other disorders beyond the simple salvage of ischemic tissues.
In HBO, a patient is inside an enclosed chamber with high pressure and 100 percent oxygen. HBO has been in use in China to treat carbon monoxide poisoning, but not for wound care. This will be a new application for HBO in China.
“It’s very exciting that these physicians came to visit because this is something that is needed in China, and it is an international collaboration,” comments Dr. Lo. “The visit basically shows that another service at Loma Linda has been recognized for service excellence on an international level.
“This started at Loma Linda as one physician’s crusade to incorporate wound care into a comprehensive treatment plan and has grown with the support of people like James Couperus, MD; Philip Gold, MD, chief of pulmonary and critical care medicine; and the administrative team at Loma Linda University Medical Center.
“I believe helping to develop health care like this in China fits with the mission of the Medical Center to ‘make man whole’ nicely,” says Dr. Lo.
Hyperbaric oxygen treatment has been shown to be effective for a number of medical and surgical conditions either as the primary treatment or as an adjunct to other conventional measures. In certain situations, it can mean the difference between success and failure in the management of an infection and/or ischemic wound. Currently there are 14 conditions approved by the UHMS for treatment and accepted by Medicare, Medi-Cal, and most other insurance carriers.
1 Air or gas embolism
2 Carbon monoxide poisoning and smoke inhalation
3 Clostridial myonecrosis (gas gangrene)
4 Crush injury, compartment syndrome, and other acute traumatic ischemias
5 Decompression sickness
6 Enhancement of healing in selected problem wounds
7 Exceptional blood loss anemia
8 Necrotizing soft tissue infections
9 Osteomyelitis (refractory)
10 Radiation tissue damage
11 Compromised skin grafts and flaps
12 Thermal burns
13 Intracranial abscess
14 Diabetic wound of the lower extremity
HBO, as with any therapy, can have side effects ranging from barotrauma of the ears to confinement anxiety, sinus squeeze, temporary progressive myopia, seizure, and alterations in pulmonary mechanics and gas exchange due to oxygen toxicity. Patients are closely monitored for early manifestations of seizure or O2 toxicity during their treatments.
Confinement anxiety, or claustrophobia, occurs in approximately 10 percent of patients treated in a monoplace chamber and is generally reduced by emotional support and reassurance from trained staff.
The hyperbaric medicine service at Loma Linda University Medical Center started in 1981 with one monoplace chamber. The service currently has four chambers with the capability of treating all types of patients including those needing ICU care and ventilator support. Each chamber can accommodate patients up to seven feet in height and the largest chamber can cater to patients weighing up to 500 pounds. The chamber walls are constructed of clear acrylic, giving the patient a clear view around them, and each chamber is equipped with a television and VCR. The patient may also choose to listen to music or simply sleep during their treatment. A chamber operator is present at all times.
Hyperbaric oxygen has become an integral part of the multidisciplinary approach to the management of patients with problematic wounds seen at the wound care center. Patients with a wide variety of problem wounds can be seen there for help in the healing process.
A quarter of patients coming to the Medical Center for wound care receive hyperbaric treatments. Yearly, 130 patients receive hyperbaric treatments.
Each treatment session lasts 90 minutes, and a patient receives a course of treatment that consists of between 20 and 30 sessions.
By Preston Clarke Smith